Rosacea Management Guidelines

Introduction to Rosacea

Rosacea is a chronic inflammatory skin disease affecting the central face, characterized primarily by persistent facial redness with periodic intensification and/or phymatous changes, which can be effectively controlled through trigger avoidance, gentle skincare, and appropriate medical treatments 1
The diagnostic features of rosacea include persistent centrofacial erythema with periodic intensification and phymatous changes, while associated features may include flushing, telangiectasia, inflammatory papules and pustules, ocular manifestations, burning or stinging sensations, facial edema, and dry appearance 1

Identifying and avoiding personal triggers is fundamental for rosacea control, including sun exposure, hot beverages, spicy foods, alcohol, temperature extremes, stress, and certain skincare products 1, 2
Gentle skincare measures include using mild, non-abrasive cleansers, applying gentle, fragrance-free moisturizers, and daily broad-spectrum sunscreen with a minimum SPF 30, while avoiding harsh scrubs, alcohol-based products, and fragranced products 1, 2

First-line topical options for rosacea include azelaic acid 15% gel/foam, metronidazole 0.75% or 1% gel/cream, and ivermectin 1% cream to reduce inflammation and itching, as recommended by the British Journal of Dermatology 3
For moderate cases, consider a combination of topicals and encapsulated benzoyl peroxide 5% (E-BPO 5%) for inflammatory lesions, as recommended by Drugs 2
The British Journal of Dermatology recommends adding oral doxycycline (40mg modified-release or 50-100mg daily) for persistent itching or moderate-severe cases, with 40mg being non-inferior to 100mg and having fewer side effects 3

The British Journal of Dermatology suggests continuing with maintenance therapy using the minimum effective regimen after 4-6 weeks of treatment and assessing response 3
If eye symptoms are present, consider referral to ophthalmology, as recommended by the British Journal of Dermatology 3
Inconsistent management, including lack of long-term adherence to both trigger avoidance and medical therapy, can hinder effective control of rosacea 2
Misdiagnosis of rosacea can occur, as it can be mistaken for acne, seborrheic dermatitis, or lupus erythematosus, with the key distinguishing feature being persistent centrofacial erythema 1